Matching what nurses learn in the classroom to what they encounter in the field is a major problem. According to Mackey and Bassendowski (2017), many nurses disclose that they suffered from anxiety in their initial days in the field. All nurses experience a theory-practice gap at some point as they discharge their mandates (Mackey & Bassendowski, 2017). Needham, McMurray, and Shaban (2016) cite the clinical learning environment (CLE) as one of the factors that cause the theory-practice gap in the nursing field.
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The unpredictable nature of CLE makes it hard for nursing instructors to determine the precise skills to impart to students. The gap between nursing education and practice hinders the implementation of research-based practice in health care facilities. A study conducted on nursing students revealed that they all suffered from nervousness at the start of clinical placement (Mackey & Bassendowski, 2017).
These findings highlighted four key factors that contributed to a theory-practice gap. They included a poor partnership between health care facilities and colleges, the lack of socialization to the clinical environment, failure to involve students in practical lessons, and the role of nursing educators in equipping learners with pertinent skills.
College-Based Learning and Skills Acquisition
Students require participating in experimental lessons to eternalize the motor aspects of a skill. Needham et al. (2016) emphasize that practice does not only equip students with skills but also helps them to execute their responsibilities in a coordinated and polished manner. Many nursing institutions do not reserve adequate time for engaging learners in practical lessons. Needham et al. (2016) blame a lack of practice in specific nursing areas as the primary factor that leads to anxiety amid nurses in early placement.
The majority of the nursing students agree that they do not get enough practice when studying, which results in them lacking confidence if asked to apply what they have already learned. Research in the theory-practice gap recommends the use of an on-the-job teaching approach to endow nursing students with skills (Needham et al., 2016). These learners say that they feel unqualified because they do not acquire practical knowledge in classrooms.
While skills can be taught in class, nursing education ought to focus on the emotional and cognitive aspects of dexterity. Nonetheless, most colleges do not use this mode of teaching (Needham et al., 2016). Instead, they concentrate on equipping learners with theoretical experience at the expense of spending time doing experiments in controlled settings. It becomes difficult for learners to “relate to the philosophy and research behind the skills being taught” (Needham et al., 2016, p. 134). Some students discharge duties in a certain manner not because they understand why it should be done that way but since it is what they were taught.
There is a need to review teaching strategies that nursing schools use and to have sufficient time for practical lessons. Needham et al. (2016) state, “Student nurses often take on board stereotypical culture and values of all novice practitioners in that they cannot see the forest for the trees” (p. 136). These scholars do not have a chance to deliberate and gain skills through practice. Needham et al. (2016) insist that nursing education does not value a task-based approach to patient care.
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Instead, it focuses on training learners in how to offer comprehensive healthcare services. In the process, students get preoccupied with learning how to provide wide-ranging services and forget simple procedures like examining patients, which are critical. Ryan (2016) alleges that failure to use a systematic method to instill knowledge in nursing students results in them developing anxiety and not being able to discharge their responsibilities adeptly. It is not hard to see nurses who are incapable of doing simple duties like recording patients’ information and processing them for admission.
Socialization to Clinical Setting
Research shows that participating in practical lessons allows students to gain nursing values that are helpful to their careers. Nevertheless, in reality, covert principles rule nursing practices, thereby disrupting these values. Ryan (2016) posits, “Poor professional socialization has proven to cause increased anxiety levels in students and create a barrier between theories that learners are taught and how they are permitted to apply them in the clinical setting” (p. 1551).
Research by Moonaghi, Mirhaghi, Oladi, and Zeydi (2015) cites role models, especially educators, as helpful in promoting support and socialization. Nursing educators help students to acclimatize to clinical practices. Hence, nurses can easily apply the theories that they learn in class in a medical setting.
The intricacies associated with learning in a clinical setting have resulted in scholars conducting research on the prevailing conditions that depict this environment. They include interpersonal interactions, the psychosocial mood in the medical units, and the apparent positive and negative experiences (Moonaghi et al., 2015). Most studies show that the clinical environment does not offer a good learning atmosphere for nursing students. An unhealthy relationship between students and clinical nurses hinders the learners’ capacity to exercise the skills that they acquire in classes. The inability of nursing students to adjust to clinical settings underscores the existence of the theory-practice gap.
Role of Clinical Instructor
Nurse educators play a significant role in bridging the gap between what nurses learn and practice in the medical field. According to Embo, Driessen, Valcke, and Van der Vleuten (2015), these instructors support role modeling and aid in the creation of workplace relations. Embo et al. (2015) argue that clinical supervision should serve as an essential learning instrument for nursing students. However, many clinical educators treat it as a type of administrative surveillance, depriving students of an opportunity to learn. Embo et al. (2015) maintain that clinical administration ought to enable nursing students to gain experience through reflection.
Instead, many supervisors use a “learning by doing approach” to train students, which is not helpful (Embo et al., 2015). It is imperative to appreciate that medical practice is invaluable to nursing students because they get an opinion on their performance. Studies reveal that nurses acquire knowledge and build proficiency by deliberating on their practice during clinical supervision (Embo et al., 2015). Nevertheless, the learning approach that most clinical instructors exploit deny nursing students room to reflect on their performance, thus creating a disconnect between theory and practice.
In most clinical settings, nursing students do not have the liberty to do things according to what they have learned in class. Instead, they are expected to adjust to the culture of the health facility where they have been assigned. Many nurses allege that some supervisors keep on reminding them about how things are done in their facilities, denying them space to exercise their skills. In the process, nurses try to acquire hands-on experience from their supervisors and forget to implement what they learn in the classroom. These nurses are afraid of trying new things as they might violate established norms.
Partnership Between College and Nursing Education
There is a need for teamwork between classroom instructors and off-college teachers. Studies show that patient assessment techniques, which are taught in class, often differ from those that the clinical placement teachers practice (Woods et al., 2015). This discrepancy leads to nursing students encountering challenges when dealing with patients; underline the need for colleges to liaise with clinical staff.
Woods et al. (2015) claim that many nursing students admit that experience in clinical placement does not mirror what they study in classrooms. They argue that in the field, students are taught completely different things, leading to them feeling unqualified. Embo et al. (2015) assert that the lack of collaboration between nursing schools and clinical facilities has made it difficult for educators to equip learners with sufficient knowledge to handle different problems that might arise in a clinical setting.
Ryan (2016) contends that most nurses engage in medical activities, which are premised on beliefs and principles that have little or no correlation to the study of proficient practice, thus extending the theory-practice gap. The nursing college has an obligation to bestow learners with formal skills in readiness for practice.
Nursing education equips learners with theoretical skills, and hence there is a need for students to work in clinical settings to acquire practical knowledge. Many nursing students accept that there is a gap between what they learn at school and what they are expected to do in the field. The factors that contribute to this disparity include the lack of partnership between nursing schools and health care facilities and poor socialization to the medical environment.
Clinical educators also play an essential role in bridging the theory-practical gap. These teachers ought to establish a learning environment that enables nurses to reflect on their experience, therefore being able to eternalize essential skills. Nursing institutions require reserving enough time for students to partake in practical lessons. It helps them to acquire hands-on experience, which cannot be derived from theoretical classes.
Embo, M., Driessen, E., Valcke, M., & Van der Vleuten, C. P. M. (2015). Integrating learning assessment and supervision in competency framework for clinical workplace education. Nurse Education Today, 35(2), 341-346.
Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55.
Moonaghi, H. K., Mirhaghi, A., Oladi, S., & Zeydi, A. E. (2015). A journey across an unwelcoming field: A qualitative study exploring the factors influencing nursing students’ clinical education. Health Science Journal, 9(4), 1-6.
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Needham, J., McMurray, A., & Shaban, R. Z. (2016). Best practice in clinical facilitation of undergraduate nursing students. Nurse Education in Practice, 20(1), 131-138.
Ryan, E. J. (2016). Undergraduate nursing students’ attitudes and use of research and evidence-based practice – an integrative literature review. Journal of Clinical Nursing, 25(12), 1548-1556.
Woods, C., West, C., Mills, J., Park, T., Southern, J., & Usher, K. (2015). Undergraduate student nurses’ self-reported preparedness for practice. Collegian, 22(4), 359-368.